TAP 21: Addiction Counseling Competencies

236 Pages·2012·3.05 MB·English

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TA2P 211
Technical Assistance Publication Series
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov
Other Technical Assistance Publications (TAPs) include:
TAP 2 M edicaid Financing for Mental Health and Substance Abuse Services for Children and
Adolescents PHD581
TAP 13 Confidentiality of Patient Records for Alcohol and Other Drug Treatment BKD156
TAP 14 S iting Drug and Alcohol Treatment Programs: Legal Challenges to the NIMBY Syndrome
BKD175
TAP 17 Treating Alcohol and Other Drug Abusers in Rural and Frontier Areas BKD174
TAP 19 C ounselor’s Manual for Relapse Prevention With Chemically Dependent Criminal Offenders
(SMA) 06-4217
TAP 20 Bringing Excellence to Substance Abuse Services in Rural and Frontier America BKD220
TAP 21 A ddiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional
Practice (SMA) 08-4171
TAP 21-A Competencies for Substance Abuse Treatment Clinical Supervisors (SMA) 08-4243
TAP 22 C ontracting for Managed Substance Abuse and Mental Health Services: A Guide for Public
Purchasers BKD252
TAP 23 Substance Abuse Treatment for Women Offenders: Guide to Promising Practices
(SMA) 08-3929
TAP 24 Welfare Reform and Substance Abuse Treatment Confidentiality: General Guidance for
Reconciling Need to Know and Privacy BKD336
TAP 26 Identifying Substance Abuse Among TANF-Eligible Families (SMA) 05-4089
TAP 28 T he National Rural Alcohol and Drug Abuse Network Awards for Excellence 2004, Submitted
and Award-Winning Papers (SMA) 10-4183
TAP 29 Integrating State Administrative Records To Manage Substance Abuse Treatment System
Performance (SMA) 09-4268
TAP 30 Buprenorphine: A Guide for Nurses (SMA) 09-4376
TAP 31 Implementing Change in Substance Abuse Treatment Programs (SMA) 09-4377
ADDICTION COUNSELING
COMPETENCIES
The Knowledge, Skills, and
Attitudes of Professional Practice
Technical Assistance Publication (TAP) Series
21
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
1 Choke Cherry Road
Rockville, MD 20857
A
cknowledgments
A number of people deserve recognition for their tireless and dedicated work on this document. The pub-
lication was originally conceived and written by the National Addiction Technology Transfer Center (ATTC)
Curriculum Committee. The Committee, one of six national committees designed to serve the ATTC Network,
comprises representatives from several ATTC Regional Centers and the ATTC National Office. This group was
responsible for the original 1998 publication and for the 2000 draft on which this updated edition is based
(see page v). A second Committee convened in 2005 to update and finalize the current document (see page
vi). Karl D. White, Ed.D., and Catherine D. Nugent, M.S., served as the Center for Substance Abuse Treatment
(CSAT) ATTC Project Officers. Christina Currier served as the CSAT Government Project Officer.
This publication was produced by JBS International, Inc. (JBS), under the Knowledge Application Program
(KAP) contract number 270-04-7049. Lynne MacArthur, M.A., A.M.L.S., served as the JBS KAP Executive Project
Co-Director; Barbara Fink, RN, M.P.H., served as JBS KAP Managing Project Co-Director; Dennis Burke, M.S.,
M.A., served as KAP Deputy Director for Product Development; and Jennifer Frey, Ph.D., served as the KAP
Deputy Director for Knowledge Application. Other JBS KAP personnel included Elliott Vanskike, Ph.D., Senior
Writer; Wendy Caron, Editorial Quality Assurance Manager; Frances Nebesky, M.A., Quality Control Editor;
and Pamela Frazier, Document Production Specialist.
d
isclAimer
The views, opinions, and content expressed herein are those of the expert panel and do not necessarily re-
flect the views, opinions, or policies of CSAT, the Substance Abuse and Mental Health Services Administration
(SAMHSA), or the U.S. Department of Health and Human Services (HHS). No official support of or endorse-
ment by CSAT, SAMHSA, or HHS for these opinions or for particular instruments, software, or resources is
intended or should be inferred.
P d n
ublic omAin otice
All materials appearing in this volume except those taken directly from copyrighted sources are in the public
domain and may be reproduced or copied without permission from SAMHSA/CSAT or the authors. Citation
of the source is appreciated. However, this document may not be reproduced or distributed for a fee without
the specific, written authorization of the Office of Communications, SAMHSA, HHS.
e A P c
lectronic ccess And rinted oPies
This publication may be ordered from SAMHSA’s Publications Ordering Web page at http://www.store.samhsa.
gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). The document can
be downloaded from the KAP Web site at http://www.kap.samhsa.gov.
r c
ecommended itAtion
Center for Substance Abuse Treatment. Addiction Counseling Competencies: The Knowledge, Skills, and At-
titudes of Professional Practice. Technical Assistance Publication (TAP) Series 21. HHS Publication No. (SMA)
08-4171. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.
o o
riginAting ffice
Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for
Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry
Road, Rockville, MD 20857.
HHS Publication No. (SMA) 08-4171
First printed 2006
Revised 2007, 2008, 2009, and 2011
ii
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ontents

Curriculum Committees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v

1998 National ATTC Curriculum Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

2005 Update Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Section 1: Transdisciplinary Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
I. Understanding Addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
II. Treatment Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
III. Application to Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
IV.
Professional Readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Section 2: Practice Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
I. Clinical Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
II. Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
III. Referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
IV. Service Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
V. Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
VI. Client, Family, and Community Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
VII. Documentation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
VIII. Professional and Ethical Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Section 3: Additional Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161

Cultural Competency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Internet Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Attitudes Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Recovery Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

Section 4: Appendices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169

A. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170

B. The Competencies: A Complete List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

C. National Validation Study: Defining and Measuring the Competence

of Addiction Counselors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

D. Complete Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196

E. Other Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224

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c c
urriculum ommittees
1998 n Attc c c
AtionAl urriculum ommittee

Affiliations indicated below are those at the time of the work.
David A. Deitch, Ph.D. (Chair) Alan M. Parsons, M.S.W., ACSW
Pacific Southwest ATTC Northeastern States ATTC
University of California San Diego State University of New York at Albany
La Jolla, California Albany, New York

G.E. Carrier, Ph.D. Nancy Roget, M.S., MFT, LADC
Representing the Texas ATTC Mountain West ATTC
Alvin Community College University of Nevada–Reno
Alvin, Texas Reno, Nevada

Steven L. Gallon, Ph.D. Susanne R. Rohrer, RN, M.B.A.
Northwest Frontier ATTC Center for Substance Abuse Treatment
Oregon Health and Science University Substance Abuse and Mental Health
Salem, Oregon Services Administration
Washington, D.C.
Paula K. Horvatich, Ph.D.
Mid-Atlantic ATTC Anne Helene Skinstad, Psy.D.
Virginia Commonwealth University Prairielands ATTC
Richmond, Virginia University of Iowa
Iowa City, Iowa
Mary Beth Johnson, M.S.W.
ATTC National Office Patricia L. Stilen, LCSW, CADAC
University of Missouri–Kansas City Mid-America ATTC
Kansas City, Missouri University of Missouri–Kansas City
Kansas City, Missouri
Hendi Crosby Kowal, M.P.H.
DC/Delaware ATTC Susan A. Storti, RN, M.A.
Danya International, Inc. ATTC of New England
Silver Spring, Maryland Brown University
Providence, Rhode Island
Linda Nicholas
Great Lakes ATTC Elleen M. Yancey, Ph.D.
University of Illinois–Chicago Southeast ATTC
Jane Addams School of Social Work Morehouse School of Medicine
Chicago, Illinois Atlanta, Georgia
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Addiction Counseling Competencies
2005 u c
PdAte ommittee
Paula K. Horvatich, Ph.D. (Chair) Randolph Muck, M.Ed.
Mid-Atlantic ATTC Center for Substance Abuse Treatment
Virginia Commonwealth University Substance Abuse and Mental Health
Richmond, Virginia Services Administration

Rockville, Maryland
Carol Davidson, M.S.W., CDP
Evergreen Treatment Services
Paul D. Nagy, M.S., LCAS, LPC, CCS
Seattle, Washington Duke Addictions Program

Duke University Medical Center
Steven L. Gallon, Ph.D.
Durham, North Carolina
Northwest Frontier ATTC

Office of Alcohol and Drug Abuse Programs
Nancy Roget, M.S., MFT, LADC
Salem, Oregon Mountain West ATTC

University of Nevada–Reno
Michael Hoge, Ph.D.
Reno, Nevada
Annapolis Coalition

Yale University
Gerard J. Schmidt, M.A., LPC, MAC
New Haven, Connecticut NAADAC–The Association for Addiction

Professionals
James Holder, M.A., LPC-S, MAC
Valley HealthCare System
National Association for Alcohol and
Morgantown, West Virginia
Drug Addiction Counselors

McLeod Behavioral Health
Michael Shafer, Ph.D.
Florence, South Carolina Pacific Southwest ATTC

Tucson, Arizona
Mary Beth Johnson, M.S.W.
ATTC National Office
James L. Sorensen, Ph.D.
University of Missouri–Kansas City San Francisco General Hospital
Kansas City, Missouri University of California–San Francisco

San Francisco, California
Linda Kaplan, M.A.
National Association for Children
Patricia L. Stilen, LCSW, CADAC
of Alcoholics Mid-America ATTC
Rockville, Maryland University of Missouri–Kansas City

Kansas City, Missouri
Captain Florentino (Tino)
Merced-Galindez, M.S.N., RN Deborah Stone, Ph.D.
Center for Substance Abuse Prevention Center for Mental Health Services
Substance Abuse and Mental Health Substance Abuse and Mental Health
Services Administration Services Administration
Rockville, Maryland Rockville, Maryland

Pamela Waters, M.Ed., CAPP
Southern Coast ATTC
Florida Certification Board
Tallahassee, Florida
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f
oreword
Counselors who treat people with substance use disorders do life-changing work on a daily
basis, amid difficult circumstances that include staff shortages, high turnover, low salaries,
and scant program funding. Counselors come to this important work by various paths and
with vastly different skills and experience. The diversity of backgrounds and types of
preparation can be a strength, provided there is a common foundation from which counselors
work. This publication addresses the following questions: What professional standards should
guide substance abuse treatment counselors? What is an appropriate scope of practice for
the field? Which competencies are associated with positive outcomes? What knowledge,
skills, and attitudes (KSAs) should all substance abuse treatment professionals have in
common?
Workforce development is essential to the field of substance use disorder treatment.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has included
workforce development in its Matrix of Priority Programs. A major focus of this workforce
development strategy is improving the competencies of professionals in the field. This updated
edition of Technical Assistance Publication (TAP) 21: Addiction Counseling Competencies:
The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) is a key
component of that strategy.
In 1998, in cooperation with its Addiction Technology Transfer Center (ATTC) Network,
SAMHSA published TAP 21, a comprehensive list of 123 competencies that substance abuse
treatment counselors should master to do their work effectively. TAP 21 has been used to
develop and evaluate addiction counseling curricula, advise students, and assess counseling
proficiencies.
The overarching competencies in this updated version of TAP 21 remain largely unchanged
from the original TAP 21. The KSAs have been changed from those in the 1998 edition when
necessary, in light of new thinking in the field. The competencies and the KSAs in practice di-
mensions that address clinical evaluation and treatment planning have been revised to reflect
changes in the field. The competencies are defined by sublists of the KSAs needed to master
each competency. Bibliographies have been supplemented with new publications through 2005.
The format has been improved to make the information more accessible and useful.
SAMHSA’s TAP series provides a flexible format for the timely transfer of important technical
information to the substance abuse treatment field. This updated version of TAP 21 exemplifies
the flexibility of the TAP format. We are grateful to the members of the ATTC Network and staff
and to all those who participated in the validation and updating of these competency lists.
Pamela S. Hyde, J.D.
Administrator
Substance Abuse and Mental Health Services Administration
H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
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